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Ann Thorac Surg 2000;70:866-871
© 2000 The Society of Thoracic Surgeons
a The Sanger Clinic, Charlotte, North Carolina, USA
b Cor Therapeutics, South San Francisco, California, USA
c Duke Clinical Research Institute, Durham, North Carolina, USA
d Mid-America Heart Institute, Kansas City, Missouri, USA
Address reprint requests to Dr Dyke, The Sanger Clinic, 2555 Court Dr, Suite 200, Gastonia, NC 28054
e-mail: cdyke{at}mindspring.com
Presented at the Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Ft. Lauderdale, FL, Jan 31–Feb 2, 2000.
Background. The platelet GP IIb/IIIa inhibitor eptifibatide improves outcomes in patients with acute coronary syndromes. Patients requiring emergent coronary artery bypass grafting, however, may be at increased risk for bleeding if exposed to eptifibatide. Data from the PURSUIT trial were reviewed to assess this risk in patients undergoing coronary surgery immediately after exposure to eptifibatide.
Methods. In PURSUIT, 10,948 patients who presented with non-ST segment elevation acute coronary syndromes were prospectively randomized to receive eptifibatide (180 µg/kg bolus plus 2 µg/kg/min infusion) or placebo. A total of 78 patients underwent immediate coronary artery bypass surgery within 2 hours of cessation of study drug (placebo, n = 46; eptifibatide, n = 32). Clinical outcome, bleeding, and transfusion requirements within this subset were examined.
Results. Major bleeding was not different between groups, occurring in 64% of patients receiving placebo and 63% of patients receiving eptifibatide. The incidence of blood transfusion was similar as well (57% vs 59%). Postoperative thrombocytopenia occurred less often after eptifibatide exposure. Perioperative myocardial infarction was significantly reduced in patients who received eptifibatide (46% vs 22%, p < 0.05). There was no difference in perioperative stroke (2.2% vs 6.3%) or mortality (6.3% vs 6.5%).
Conclusions. Patients may safely undergo coronary artery bypass surgery within 2 hours of discontinuation of eptifibatide. Eptifibatide infusion in the immediate preoperative period had no adverse clinical effects, but did significantly decrease the incidence of perioperative myocardial infarction. Additionally, platelet counts after surgery were higher in the group of patients who received eptifibatide, perhaps indicative of a platelet-sparing effect during cardiopulmonary bypass.
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Ann. Thorac. Surg. 2000 70: 871-872.
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